Health Law Enrollment in U.S. to See Slow Start Next Week

Enrollment in the Affordable Care
Act’s public health exchanges, a key effort to reach people
without health insurance, will start slowly, a senior Obama
administration official said.

While the U.S. exchanges begin selling insurance plans on
Oct. 1, the medical coverage doesn’t take effect until Jan. 1, a
gap that may lead some Americans to hold off on purchases until
the last minute, said the official, who asked not to be
identified because the person wasn’t authorized to speak on the
record. The biggest portion of sign-ups will occur closer to
January, the officials told Bloomberg News today.

Such a scenario would mimic patterns surrounding the
initial enrollment periods for Medicare Part D prescription drug
plans in late 2005 and Massachusetts’s health-care law in 2006.
The Obama administration has said it’s seeking at least 7
million people to enroll through the Affordable Care Act by
April.

“A majority of individuals would say, ‘If I’m not going to
get my insurance until Jan. 1, then I’m certainly not going to
pay my premium on Oct. 1,’” Dan Schuyler, a director at the
consulting firm Leavitt Partners in Salt Lake City, said in a
telephone interview. “Realistically, a lot of people will not
actually buy the product until the end of November at the
earliest.”

The $1.4 trillion Affordable Care Act seeks to extend
coverage to most of the nation’s 50 million uninsured by
expanding state Medicaid programs and creating government-run
insurance exchanges, with many people eligible to have their
premiums subsidized by taxpayers. About 25 million Americans by
2016 are expected to have gained coverage under the health law,
commonly known as Obamacare.

Judging Success

The success of the exchanges probably can’t be judged until
December or beyond, said Schuyler, who wasn’t part of the
briefing. The initial open-enrollment period runs from Oct. 1
through March 31, 2014.

The Obama administration does expect some glitches with the
program, one official said, describing it as still in a testing
period. The officials said they are confident people will be
able to sign up for plans on Oct. 1 if they want to, despite
some technical problems with the websites and coordination
between federal and state agencies.

“We should not look at enrollment in October or November
as the final measure of what enrollment in the marketplaces will
be when the open-enrollment period closes,” said Juliette
Cubanski, an associate director of Medicare policy analysis at
the Kaiser Family Foundation. “We need to give the outreach
campaigns time to take effect, just as they did in ‘Part D.’
People got the message over a period of several months.”

Medicare Roll-Out

Enrollment in government health programs has traditionally
been slow to start. The Children’s Health Insurance Program,
which began in 1998, saw 897,000 people enrolled in its first
year, Larry Levitt, a senior vice president at the Kaiser Family
Foundation, said in a February report published on the website
of the Journal of the American Medical Association. Four million
children were enrolled within five years.

Medicare’s prescription drug program, known as Part D, also
“ran into early problems” that slowed initial enrollment,
Levitt wrote. It rebounded and “has operated reasonably
smoothly since then,” he said. More than 30 million Medicare
beneficiaries are in the drug plans now.

The Obama administration will be able to track the progress
of Americans who start to sign up at healthcare.gov, beginning
next week, and nudge them with e-mail reminders if they don’t
finish the process in October, the officials said. They offered
no specific estimate for how many sign-ups they expect.